1
Achieving Legacy System Retirement and
Data Consolidation
Session 184, February 13, 2019
Lisa Stump, SVP and CIO, Yale New Haven Health
Bill Hudson, ACIO and VP of IT Operations, John Muir Health
2
Lisa Stump
Has no real or apparent conflicts of interest to report.
Bill Hudson
Has no real or apparent conflicts of interest to report.
Conflict of Interest
3
Learning objectives
Background
Deciding on an archive strategy
The path to success
Principles of archiving: what to archive
Data governance: structure for a plan
Engaging Operations: foundation for a plan
Recommendations and lessons learned
Agenda
4
Illustrate the advantages and challenges of consolidating legacy
data in a central archive
Illustrate how to build the business case for legacy system
retirement and consolidation of legacy data into an active archive
Define the organizational roles to involve in the process to achieve
successful adoption of a solution
Define the critical principles of legacy data consolidation and
legacy system decommissioning and discuss how to apply them
Show the lessons learned from a legacy data consolidation and
retirement program
Learning Objectives
5
Drivers for Enterprise Legacy
Retirement & Archiving
Healthcare Market Transformations
Federal mandates
ICD-10
Meaningful Use
Acquisitions and mergers
Budgetary pressure to consolidate
applications
Data-driven healthcare
Streamline, Simplify, Save
Legacy Application
Replacement &
Retirement
6
Drivers for Enterprise Legacy
Retirement & Archiving
Compliance: 7 28 years
Continued need for access to clinical
data
Revenue cycle: billing continues
Audits: RAC, Medicare, Medicaid,
commercial carriers
Research
Cost of maintaining legacy
applications
Data spread over disparate systems
Legacy Retirement
Active Archiving
7
Enterprise Legacy Landscape at
JMH
Reviewed all 500 of our applications
Identified 162 candidates
Worked with key staff to identify data elements to retain and
applications to decommission
We focused for 3 – 3 ½ months on the “Legacy Application
Decommissioning Assessment”
8
Enterprise Legacy Landscape at
YNHHS
Prioritized legacy clinical and revenue cycle applications post-
EMR consolidation
Timing based on data size and legacy maintenance cost
Worked with key staff to identify data elements to retain
Emphasized clinical benefit of extending longitudinal record back
in time
9
Why use an enterprise, centralized,
active archive?
Reduce data footprint through selective archiving
Create single point of access/retrieval
Maintain data usability
10
Active vs. Static Archive
Will the data be accessed often?
Examples: HIM staff responding to ROI requests;
Billers accessing for billing functions;
HR staff responding to audits;
Clinicians accessing clinical records
Is seamless access via other applications important or
beneficial?
Example: Access lab records held in the archive via the new EMR
If YesIf Yes ActiveActive
11
Use Cases & Secondary Use
Archive used for day-to-day functions
Release of Information
Revenue cycle, billing
Patient care
HR functions
Archive used to mine data for special requests, such as CDC
study requests
12
Archiving Options Considered
Expensive and difficult to manage
Retain the legacy
system
Non-compliant, high risk, and expensive
Decommission the
legacy system and
destroy data
Print to paper, archive to PDFBackup raw data
Static
Active
Enterprise archive
with end user GUI
13
Why We Used an Enterprise Active
Archive
Not a “typical” archive
Includes workflow functionality
Billing accounts for active A/R (2+ years after last DOS)
Release of Information
Interoperability
Allows for real-time end user access
Reporting
Discrete data elements and document images
Secondary use of data
Consistent workflow
14
The Path to Success
Building a business case
Establishing data governance
Engaging stakeholders
Overcoming archiving challenges
Project planning
Choosing the systems to retire
Choosing the data to archive
Moving quickly to ensure adoption
Communicate, Communicate, Communicate
15
Critical Success Factors
Achieve leadership support for sun-setting all applications
Involve department leadership to avoid resistance to
decommissioning
Successful data migration into active archive completed before
decommissioning key dependency
Teamwork
Utilize efforts among many departments instead of
maintaining dedicated resources
Technology
Active archive, ability to handle required workflow
Effective communications
Scope is broad and timeline is long
16
Building a Business Case
Use Cases
Revenue Cycle Clinical
Data
Retention
Guidelines
Reimbursement/payment
history records: 10 years
Master patient index/visit
history: permanently
Adult records: 10 years
from most recent visit
Minor records: 28 years
Use Cases
Billing accounts; payment
posting
Financial reporting
Interface with billing
systems
Insurance & cash
collections
RAC audit responses
Physicians need to
reference for point of care
clinical history
HIM staff ability to
respond to ROI requests
17
Building a Business Case
Expected components of cost savings
Software support fees (top priority)
Hardware support fees
Internal support/help desk staff
Hardware refresh
Data center costs
18
Building a Business Case
Annual Cost Savings
$0
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000
$3,000,000
$3,500,000
1 2
Pre-project legacy costs Post Project Costs
Annual Savings
Yale
JMH
19
Yale
JMH
Annualized Legacy Support Fees only
$2,980,000
$2,780,000
Annualized Active Archive fees/costs
(Including new equipment)*
$326,000
$304,000
Net Savings
$2,654,000
$2,476,000
Additional cost savings not calculated:
Net hardware refresh & data center costs
Net savings on internal support/help desk staff
* For Yale, no new equipment; for JMH, new hardware figured into
self-hosted datacenter costs; Cost of learning new system:
negligible, easy to use.
Building the Business Case
Illustrate Savings with ROI Analysis
20
What to Archive
Workflow and User Access
No workflow,
no GUI
No workflow,
no GUI
Replicate legacy
look, feel, and
workflow
Replicate legacy
look, feel, and
workflow
0% 100%
Seek a balance based on need of
specific data set.
We retained essential workflow as
determined by end users and
governance group.
21
What to Archive
Amount of Data to Retain
Discard all data from
applications
Discard all data from
applications
Keep all data from
applications
Keep all data from
applications
0% 100%
Seek a balance based on need
of specific data set.
Legal and Compliance agree on
data to retain.
22
Enterprise Data Governance
Model employed at Yale New Haven Health
All projects led through IT, providing consistent leadership
IT had over-arching responsibility for selecting applications to
retire and data to be retained, with input from business units
and compliance
SMEs from the business units performed data validation and
software testing/acceptance
SMEs who knew the legacy systems but had moved on to
analyst roles within the organization were tapped for the
enterprise archiving project
23
Enterprise Data Governance
Model employed at John Muir Health
Governance board developed that selected applications to retire
and data to retain
Comprised of Compliance, Legal, IT, HIM, Revenue Cycle,
Clinical
Needed guidance and buy-in by all data stakeholders
IT led the projects, with SMEs for testing and validation
JMH employs an active archive expert who knows and supports
the enterprise archiving system, just like any other major
application
24
Engaging Operations
Evaluating Data for Enterprise Archiving and
Applications for Retirement
Legacy application-specific
questionnaire completed
for each application (JMH)
RFP conducted for
archiving options
Confirmed data retention
periods through Legal,
HIM, and Compliance sub-
committees
Project planning prioritized
based upon cost reduction
and contractual obligations
Stakeholders
Clinical
HIM
Research
Legal
Compliance
Revenue
Cycle
25
Types of questions: how the information was used, any reporting
needs, their perception/interpretation of what the future
requirements would be
Who was interviewed: direct operational users and their
supervisors
Departments:
HIM: any legal medical record retention requirements
Legal: regulatory/legal considerations
Compliance: any retention requirements related to HIPAA
and other regulations
Treasury: advise regarding the financial systems
Interviewing Operations
26
Business Engagement
Legacy Retirement Planning Discussions
Stakeholders
Clinical
HIM
Research
Legal
Compliance
Revenue
Cycle
Set expectations: not an
identical replication of the
legacy application
Involved operations team in
archive decision
Decided on an Active
Archive
27
Project Overview
Next phase after new HIS
An active archive was selected to address the following requirements:
Provides longitudinal patient records that indicate original legacy
system
Supports EMR integration patient context viewing
All YNHHS financial data will remain in an “active” state (complete
billing functionality) to accommodate compliance, billing, and
collection functions for a minimum of ten years
All YNHHS clinical data will be available to providers, auditors, and
researchers for a minimum of ten years
Meets ITS security and infrastructure standards
Enables retirement of legacy systems post migration to the active
archive, realizing cost savings
28
Overcoming Enterprise Archiving
Challenges
As an enterprise program, projects are rolled out over time
Worked with vendor to test and stage the data ahead of
migrating it into the database, minimizing any downtime
Managing end user expectations
Actual needs, define use cases
Central v. local storage
Archive will not replicate legacy system
29
Enterprise Archive Cycle
Determine which applications to decommission
Discovery
WHO: Involve business unit leadership, Compliance, Legal
WHEN: Shortly after selection of new HIS
WHAT: Set criteria, identify use cases for legacy data: clinical, revenue
cycle, ERP
Choose technology and service Enterprise Active Archive
Solution
Involve business units in decision
Get a “partner” to help solve problems; technology to manage workflow
Plan retirement phases
Planning
Migrate data to Enterprise Active Archive & Retire Legacy Apps
Implement
Phased in over several years
Active Archive Progression at YNHHS
SCM
Jan ‘16
Cerner
Sept ‘16
3M
Chartview
Oct ‘17
Centricity
EMR
Sept ‘17
QuadraMed
InteGreate
(McKesson)
HAC
(Horizon
Amb Care -
McKesson)
Med-
Informatix
Medipac
Feb ‘16
SDK
July ‘16
Meditech
May ‘18
Clinical Data (read only)
Financial Data (read/write)
31
Enterprise Active Archive
Integration with new EMR
Easy access to legacy data from
within new EMR under the
navigator section “PreEpicEMR
32
Quick Adoption
Uneventful go-live no calls from users, including physicians
The Active Archive was easy to use
Configured for end users
Use cases were satisfied
Stakeholders were included in the selection and implementation
process
33
Start early ideally at the same time as selection of new HIS or
during merger
Include the business unit stakeholders: Revenue Cycle, Clinicians,
HIM, Finance/HR, IS
Manage expectations within the organization with a clear vision,
project plan, and budget
Engage in data retention ‘roadmapping
Set expectations early active archive vs. the legacy applications
Ensure a successful program with your own internal project
manager/coordinator
Ensure data validation beyond a simple record count test
Recommendations/Lessons Learned
34
Thank you! Please complete your online session evaluation!
Questions?
Lisa Stump
Senior Vice President and CIO
lisa.stump@ynhh.org
Bill Hudson
Associate CIO, VP of IT Operations
bill.hudson@johnmuirhealth.com